Acid Reflux During Chemotherapy

How cancer treatment can trigger reflux and what you can do about it

AMBULATORY CHEMOTHERAPY
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Acid reflux—when stomach acid or bile flows up from the stomach into the esophagus, resulting in irritation—is a common digestive condition in general, but your risk of it goes up if you are receiving or have completed chemotherapy. The medications used in this form of cancer treatment are potent, as you've likely already discovered, and your gastrointestinal tract is not spared from related side effects. Acid reflux is one and may present with indigestion and heartburn.

These symptoms can flare after meals, during normal activity, or at night when you're to get much-needed rest. Though avoiding all side effects of chemotherapy is not possible, acid reflux is one that you can work to manage.

Why Chemotherapy Increases Acid Reflux

Acid reflux is common in patients undergoing chemotherapy and after treatment has ended, and this has to do with how chemotherapy drugs work.

Chemotherapy drugs target rapidly dividing cells. The problem is that they cannot tell the difference between normal, rapidly dividing cells and cancer cells, so the drugs attack them all.

When follicle cells are affected, hair loss occurs. Suppressed bone marrow leads to blood disorders. Similarly, when cells in the lining of the gastrointestinal tract are damaged, corrosive stomach acid can flow into your esophagus instead of being carefully contained.

When such acid reflux episodes occur, chest pain and a burning feeling are common. Other possible symptoms include a sore throat or lump in the throat, coughing, a sour or bitter taste in the mouth, difficulty swallowing, and asthma-like symptoms.

Compounding Causes

It is commonly thought that acid reflux, in general, is caused by an abundance of stomach acid, but that is not always the case. Contrary to popular belief, acid reflux is often a result of not having enough stomach acid and/or digestive enzymes to efficiently break down a meal. Certain foods, beverages, and over-eating can contribute to the problem.

If you were experiencing acid reflux prior to undergoing chemotherapy treatment, these potential causes could be why. If any persist or are newly relevant since starting chemo, they can compound the digestive side effects associated with your treatment.

  • Overweight, obesity, or pregnancy: These conditions put pressure on the abdomen.
  • Over-the-counter (OTC) medications and proton-pump inhibitors (PPI) to control acid reflux, which can have a boomerang effect, especially if the condition is due to low stomach acid.
  • Other medications like aspirin, Advil (ibuprofen), muscle relaxers, blood pressure medications, anti-depressants, etc.
  • Stomach infection with the Helicobacter pylori bacteria, which can either increase or neutralizes stomach acid.
  • A structural abnormality called a hiatal hernia

What to Avoid

Whether you're currently undergoing chemotherapy or you've completed your treatment and are experiencing acid reflux, it's a good idea to avoid the following to lessen the likelihood of experiencing discomfort.

  • Large meals
  • Lying down or bending over at the waist right after a meal: When you feel the need to rest, be sure to prop your head up in bed or on the couch.
  • Snacking close to bedtime
  • Eating foods that are hard to digest such as animal protein and dairy, especially late in the day
  • Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
  • Smoking
  • Wearing tight clothing or belts

You may already be avoiding many of the foods that can worsen acid reflux (citrus, tomatoes, fatty and spicy foods). They are often ones doctors advise against during chemotherapy because they can worsen side effects like diarrhea, nausea, and mouth sores.

If you have special nutrition considerations as a result of your chemotherapy treatment, talk to your doctor or a registered dietitian to ensure you're getting the right nutrients and enough calories.

Treatments and Special Considerations

Taking digestive enzymes as well as increasing stomach acid with betaine hydrochloric acid (HCL) tablets found at health food stores may be all that's needed to relieve acid reflux for some healthy individuals. However, special considerations should be taken for those undergoing chemotherapy treatment due to related increased digestive sensitivity.

Other typical courses of treatment for acid reflux may include OTC or prescription acid-neutralizing or acid-blocking medications. Some common medications for acid reflux include:

  • Antacids like Tums, Rolaids, and Mylanta
  • Proton-pump inhibitors (PPIs) like Nexium 24h (esomeprazole), Prilosec (omeprazole magnesium), Prevacid 24h (lansoprazole), and Zegerid (omeprazole and sodium bicarbonate)
  • H2 blockers like Pepcid Complete or Pepcid AC (famotidine), Tagamet HB (cimetidine), and Axid AR (nizatidine),

Antacids

Antacids function by neutralizing stomach acid. Despite the relative safety of their ingredients, antacids should not be taken in excess of the dosing recommendations on the label or with certain types of chemotherapy due to possible neutralizing effects on chemotherapy and other drug interactions. Long-term use can result in potential adverse health outcomes.

PPIs and H2 blockers

PPIs and H2 blockers work by decreasing the stomach's production of acid. Special considerations should be heeded for people undergoing chemotherapy who may take these medications. One study showed an increase survival rate for patients with a certain type of head and neck cancer who take PPIs and H2 blockers, while another study showed a decrease in survival rate for people with gastroesophageal cancer when taking PPIs and potentially H2 blockers because of the medicine's neutralizing effects on certain types of chemotherapy.

PPIs and H2 blockers should only be used for a short period of time in healthy individuals, and presumably also in people undergoing chemo unless otherwise directed by a physician. Side effects of prolonged use may include cancer, osteoporosis, decreased stomach acid (hypochlorhydria), reduced nutrient absorption (malabsorption), increased risk of infection, as well as an increased risk of dementia, kidney disease, and death.

Acid reflux drugs come with their own risks and possible interactions with certain types of chemotherapy and other prescription medications. Always talk to your doctor about all of the medications you're taking during chemotherapy and discuss any new medications before starting them.

A Word From Verywell

Chemotherapy is not easy. Feeling sick and fatigued is not uncommon. Acid reflux can only add to this, but it may not be something you just have to live with. Mention your symptoms to your doctors and work together to find strategies that can help prevent episodes as you undergo and look back on cancer treatment. A licensed nutritionist knowledgeable about chemotherapy and digestive disorders can help you tailor your diet to meet all of your health needs.

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Article Sources

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